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My retired 70-year-old brother lives with his adult son, who works strange hours as a police officer. For various reasons we have concluded that he should not be left alone, including: wheelchair-bound, inability to bathe himself, inability to manage his meds, many chronic conditions and poorly-healed injuries, cognitive issues beyond the already-diagnosed mild memory impairment, and dependent sedentary lifestyle. Assisted living is more cost-effective (and probably better care) than a home care aide. The son is at wit’s end with the situation and wants his dad out of his condo. It would be better care for the dad, and peace of mind with less stress for the son. We have searched for and found a nice assisted living center that my brother’s limited resources can afford. We need a loving way of insisting that he make this move. It’s essentially a loving eviction. His only other option, if he refuses, is to find another living situation on his own, and he doesn’t have the wits or mobility to do so. He has an upcoming annual physical (his first in 2 years) and we have clued in the doctor about the various issues, and asked him to bring up assisted living before we discuss it further. I know this isn’t the ideal scenario for an assisted living discussion in which the loved one feels like he has some choice. It will be a difficult conversation. Any suggestions to make this talk less of a bitter pill for my brother?

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Do you know for certain that it will be a bitter pill for him? Has it ever been discussed where he was against it? He might not be.
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Seems like you have already put everything into place. Doctor would be an easy option to "break the news". Son should reinforce this with follow-on conversations, "I can't provide the care you need, even if I wanted to;" "You need and deserve to have great care and an ALF is a good way to get that"; "I could be charged with neglect since I can not provide all the care you need"... I really would hate to use the last one, but stubborn people sometimes need harsh reality to force the change.
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Perhaps a ‘white lie’ might help to make this less difficult for S to say and for B to hear. For example, S says that he has been told that he will need to transfer to another city for a month, coming up soon. “It’s policy to help ensure that all police forces are working in similar ways”, and he will have to agree. B will need to stay in AL while B is gone, and B needs to go in now to get used to it while S can still visit occasionally – he won’t be able to visit when he is transferred. S is not prepared for caregivers to be in his house while he is away and won’t be able to monitor what is going on. So AL is the only option.

This can be repeated until it’s ‘normal’. Worth thinking about this, or another option along the same lines.
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LittleBrother: Brother says 'Dad, I cannot do this anymore, my work hours as a police officer are increasing/are demanding, of course, ideally this assisted living would be safe with MANY people to take great care of you.' His physician has even backed it up
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All I can say is poor guy. Having to depend on others for almost if not everything sucks.


I'm back by the way 🙂
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Your Nephew has found himself at the crossroad. To take the lead now, or keep following.

Your Brother may not WANT to move to an AL - yet he NEEDS this level of care.

A needs assessment should highlight what care he needs. If he is still resistant to discussing, he may need fuller cognitive assessment into his 'lifestyle decision making' skills. I've met so many who use the "I'll manage" as a coverup statement but cannot manage. Neuro-Cog Ax shows up the big holes in planning & processing skills. Sad, but this is life.

If Nephew asks him to move out, that his care needs are too high for him, he must move *somewhere*, & must arrange his own care needs.

Does he really understand this?

If your Brother has memory loss &/or cognitive skills loss he may lack insight to his situation.
(Medical name: Anosognosia)

It could be a hard spot for you LittleBrother. Caught in the middle in a way. You can see Nephew's point of view but also wish to protect your Brother's rights. I've seen this play out many times now. The folk who come out the other side well, with less guilt or regrets use *common sense*. They avoid getting all twisted up with elder's rights to live how they wish even if this overrides their offspring's lives.. avoid all that putting-others-before-us talk too.

All that gets changed by cognitive decline. By accepting that, accepting your Brother needs more care than can be provided by his son (his son gets the say on that by the way) then you can discuss it with simple honesty with your Brother. That is the common sense of it.

I wish you all the best transistion possible.
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First, you verify that the doctor will say that he needs to be in assisted-living. My mother-in-law‘s doctor was quick to agree with assisted-living, saying “that’s where you need to be.” Then we just had to keep reminding father-in-law that they should do what the doctor said. Once the doctor says AL is the place for him, son tells him, assuming his dad balks, “I will not have the risk any longer of coming home to find something terrible has happened to you. I would never forgive myself.” Son uses broken record technique, repeating “I would never forgive myself.” Make an appointment to take him to lunch at the AL, you, him, son. All talk as if his moving there is a forgone conclusion. The sooner the better for all of this. As you describe his needs, he’s passed due for AL and something bad could happen where he is.
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You can't "tough love" with a person you say has "cognitive issues beyond the already-diagnosed mild memory impairment"

Your brother can no longer make informed decisions about his care. Its not what he wants, its what he needs. I do hope someone has POA makes things easier. With my Mom she was probably stage 5 out of 7. We told her she was going to a nice apartment and was going to make new friends. Had no problem with her and she acclimated well. Yes, I was lucky.

Has this AL evaluated ur brother? Usually when Dementia is involved, Memory care is recommended.
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Beatty Jun 2023
So true. I have used tough love but it does often fail to change behaviour when insight is really lacking.
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As a rose, the need is the need is the need.
Not making light of a difficult family situation although when changes are needed, a person may resist - out of fear, loss of independence, going into the unknown.

It is perhaps unfortunate that the / his son took this on and kept it going for so long. However, it is what it is now - and things must change.

While he is VERY FORTUNATE to be going to a 'good' place, he certainly won't see it that way. So many people cannot afford a 'good assisted living' facility. He is very fortunate he can. (But do not mention this.)

It is understandable he will resist and say 'No."

Clearly, he cannot manage on his own so he does not have a choice.
Talking logic in these situations - whether due to dementia or not - doesn't work. The person wants what they want and will 'kick and scream' their way through it.

I often recommend here - and believe it is a positive, healthy, way to communicate:

Offer reflective listening. You reflect back to your brother what he says, i.e.,

" I hear you saying xxx"
"I know that you don't want to go to xxx" (use his words. PERIOD.
You don't continue on with a BUT - giving logically explanation = adds fuel to the already ignited emotional fire).

You do not agree or disagree. This is the key component of this way of communicating. You are listening to him and how he feels. That is all and this is huge.

At some point, you need to realize that there is no 'easy' way to make this change.
He will resist.
He will be sad / mad, etc.
He will adjust because he has to - or he will continue to scream or let his feelings known to everyone around him. He will respond as he does.
You have no control of this.

I would continually tell him:

We / I love you.

Do not say "we are doing this FOR YOUR OWN GOOD.
Just "we love you" and we are here for you.

I would change the subject and not continue in this tug of war.
No one wins - and everyone is emotionally and psychologically depleted.

When it gets to be too much, take a break.

Walk away or leave for a while.

Do not subject yourself to ongoing sadness and torment - because you want what is best for him, and you love him, and he doesn't want what is needed / best for him.

Trust that he will adjust with time. It would / could hope a lot to get a caregiver / or a friend/care giver is there at the transition period of him moving in - so he has a friendly face / support. This is important.

Perhaps a family member could come in 3-4 a day for the first week or so?
Help him with the transition - so he won't feel so scared and alone. (And expect the screaming / resistance).

Gena / Touch Matters
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Beatty Jun 2023
Excellent.

I have a LO in need of regular respite care. Refuses & fusses. Fear plus loss of control, all that you mentioned.
We had tried many variations of "I know you don't want to BUT..." filled in with logical reasons.

That didn't work.

The logic part held no sway over strong emotions. Even when calm, processing the logicial facts seemed much diminished. Just didn't.want.to.go. Blank looks when asked about other people's needs.

The Doctor said "Arrange the respite care".

Gena, you put it in such a thoughtful & caring way yet practical way.

The end result may be the same: *arrange the care*. But when caregivers BELIEVE in what they are saying & doing, it should avoid any guilt traps. Eg I believed my LO attending respite care was necessary. I feel fine about it.
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A group meeting with a Geriatric Psychiatrist would afford all of you the opportunity to speak your truths and to present options with the help of the doctor, who can prescribe medications.

How about you and his son go pick out two places for him and let him choose, so that Adult Protective Services doesn't have to be called.
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In our case it did get a little ugly - but the choice was necessary. It was my FIL that needed to be moved and my SIL/BIL that were providing 24/7 care (they lived with him) that was no longer sustainable due to some health issues of their own and FIL's immobility. He was in a rehab facility with no further progress able to be made at the time.

He told us - and the social worker - in no uncertain terms that HE was still competent and HE had the last word and that he was going home. As Alva said, you cannot MAKE him do anything that he does not choose to do unless certain criteria are met, but you can make the choice they want uncomfortable or unachievable.

He was 100% correct- the choice was up to him. But we had a choice too. We did not have to facilitate that choice. And we said as much. That we as a family would no longer be providing his care and that if he chose to go home, he would need to hire 24/7 skilled nursing care or that he would be an unsafe discharge - because it was very clear that he was completely unable to take care of himself.

Once we took ourselves out of the equation - that severely limited HIS options. He either had to hire someone 24/7 to take care of him (which was out of his budget) or he had to agree to move to the SNF that we had found for him (a very nice place, that he could afford.) It was still his choice. He just didn't like his choices.

Many times if you take yourself (and anyone else) out of the equation that can facilitate/prop them up and be the solution and remove the roadblocks/impediments to them achieving exactly what THEY want - they are only left with what you want them to do anyway. But they are the ones that make the choice because they don't have any other option. BUT they aren't literally forced into it. Maybe figuratively, but I guess that's semantics at the end of the day.

Frankly, I'm surprised my FIL didn't hire someone for a brief period and then fire them and see what we did. But maybe he finally took us seriously.
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I always found honest straight talk using soft words is the way to go. We can take it and usually appreciate it.
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Brother/Dad, "I can't do this anymore. I found a nice place for you to live with lots of help. Would you like to visit tomorrow or Saturday?"

Keep it simple, straightforward and honest. Don't argue. Just say "I can't"
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Sometimes its easier to put the blame on ourselves:
Maybe you can use the words: I cannot lift you out of the wheelchair anymore, My job is asking me to be on call 24 hrs, My back is not good, My doctor told me to take it easy, I am tired.
Try not to use the words: You cannot take care of yourself, you are too much work, you cannot stay here any longer.
Try and stay positive about the place, mention the activities, great people that are there, let him in on the choosing of the facility.
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All you have to say “ is you are a fall risk and we are concerned that it’s not safe for you to be alone . “ I agree let the doctor have the conversation or bring him to Lunch at the AL and have the social worker show him around . He may make friends or enjoy the new activities. Glad you are helping your Nephew .
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His son is going to have to speak up and tell his dad that this is more than he can handle and it is stressful for him. He needs to tell his dad that he loves him, but he needs more care than he can provide and that they need to look for a place that can care for him 24/7.
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Brother, your care has become way more then your son is able to provide.

You will be getting a needs assessment so we can find a facility that can give you the care you need and deserve.

We love you and know how hard this is but, we know how vital it is that it happens.

Repeat as needed.
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It is never easy to get someone to want to leave their home and comfort space. Sometimes family has to take care cause we know what is best for someone that needs extra help. Try to find an assistant living that matches his needs and interest and once he is in one, try to visit a lot or hire someone for a few hours a day to keep him company. It's the feeling of being abandoned that is scary to them.
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It was my sister that needed a facility. She was unable to keep her house clean and feed herself well, was falling more frequently but could handle her meds. I had to use tough love and reasoning, i.e. I will not be able to come help you quickly as you are eight hours away from me; you could fall and injure yourself and no one would know.. She had refuse help coming in to her home but did accept meals on wheels. But, I had to do wellness checks. And engaged every person I could think of to talk about a move to IL. I used every method I could think of. Maybe an assessment from the local aging agency would help? I tell my story because my sister sounds like the dad in attitude/understanding. Definitely not easy, actually very hard, but I tried to respect her opinions when I could. But she is doing much better in a facility and it is easier on me not having to worry about her constantly. Best of luck!
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Well it is up to the son to do the hard thing, tell him he has found an assisted living place and that HE CANNOT LIVE WITH HIM ANY LONGER. Tough love is necessary, and it will be unfortunate if he cuts his son out of his life. You need to validate his feelings, and support your nephew's decision to your brother, and help him get over any hard feelings.
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Please, you know what to do.He needs more care than he is getting,For his own safety, you must move him to a safe place or have much more caregiving at home.Do the right thing for him.
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Clue the doctor to be firm and forceful. Sometimes the voice of authority carries more weight than the concerned kindness of relatives that have always been push-aroundable by the head of the family.
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By saying that dad requires more care than his son can possibly provide for him in home now while working a stressful job as a full time police officer. AL is not a house of horrors, but a way for an elder to maintain autonomy while getting the extra care they require. Present it properly and have the doctor back up the recommendation. Be sure to say you'll be visiting him often in AL and calling on a regular basis.

Not everything is negotiable in our senior years when disease and dementia set in. I would think your brother can see the toll his health situation is taking on his son and want to remedy it asap. Let's hope, anyway. If not, a legal eviction will have to take place.

Best of luck to you.
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The sad truth is that neither you, his son, nor all of you together can make the father move. Not unless they are POA and he is judged incompetent under the law, and you have the medical letters and diagnosis to prove it.

I sure wish you luck. The only way is for the son to be honest with his father that he cannot live there anymore, and that if he has to legally evict him, Dad will be homeless or left to his own devices. The father is now a legal tenant whether he pays rent or not. An eviction attorney is the only way to legally remove him. That is the hard truth.

I sure wish you luck and I sure hope you'll update us.
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LittleOrchid Jun 2023
So true. It is hard for me to understand why so many families think they have the right to make decisions for family members. Once a person has reached the age of majority in the state where they reside ALL their personal decisions are their own to make unless they are deemed incompetent in a court of law.

Families can advise, encourage, or make ultimatums (seldom a good idea), but they cannot force a family member to move, hire help, or much of anything else.

For those who may be considering moving an elder into your home, be very aware that older people's symptoms will only get worse. If your elder loved one is stubborn and willful, that will not change when they move into your house, but your ability to say yes or no changes considerably.
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